Comparison of Visual Outcome and Regression Pattern of Myopic Choroidal Neovascularization After Intravitreal Bevacizumab or After Photodynamic Therapy

PURPOSE: To compare the 1-year visual and anatomic outcomes in myopic eyes with choroidal neovascularization (CNV) treated by intravitreal bevacizumab (IVB) to those treated by photodynamic therapy (PDT). DESIGN: An open-label, consecutive, interventional case series. METHODS: Forty-four eyes of 42 consecutive patients with myopic CNV treated with PDT, and 43 eyes of 43 consecutive patients with myopic CNV treated with IVB, were evaluated. For control, 74 eyes of 71 consecutive patients with untreated myopic CNV were evaluated. The comparison of best-corrected visual acuity (BCVA) using analysis of covariance (ANCOVA) during the 12-month follow-up period was performed among the 26 IVB-treated patients without prior treatment, 35 PDT-treated patients without prior treatment, and 71 nontreated controls. RESULTS: Thirty-nine of the IVB-treated eyes (91%) had angiographic closure, and 21 (48.8%) had an improvement of >2 lines in the BCVA at I year. IVB-treated patients had significantly better BCVA than PDT-treated and control eyes at 1 year. The CNV size continued to decrease during the 12-month follow-up in the successfully treated IVB eyes, and the size did not decrease, or even increased, in 65% of the successfully treated PDT eyes. Chorioretinal atrophy developed Significantly more frequently in PDT-treated than IVB-treated eyes. CONCLUSIONS: IVB is more effective for myopic CNV than PDT. The differences in the regression pattern of CNVs and the rate of chorioretinal atrophy probably explain the better BCVA in the IVB treated eyes. (Am J Ophthalmol 2009;148:396-408. (C) 2009 by Elsevier Inc. All rights reserved.)